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Aetna Medicare Dual Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Complete (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Dual Complete (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Complete (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Texas counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual Complete (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Aetna Medicare Dual Complete (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Dual Complete (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Dual Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.70. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Dual Complete (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay costs for your drugs until your total drug costs reach $2000.00. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), and the Part D premium will be $17.70 with LIS. Once your yearly out-of-pocket drug costs reach $2000.00, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Dual Complete (HMO D-SNP) plan provides coverage for a wide range of services. This includes no copay for primary care visits, mental health services, and many therapies, as well as preventive services like annual physical exams. The plan also offers coverage for hearing aids with a maximum benefit, vision services with no copay for eye exams and eyewear, and dental services with a 20% coinsurance and an annual maximum. In terms of other benefits, this plan covers emergency and outpatient services, with varying copays and coinsurance, and offers transportation to health-related locations at no cost. The plan also provides home health services with no copay, and covers over-the-counter items up to a monthly limit. However, it's important to note that certain services like cardiac rehabilitation and additional days in a skilled nursing facility are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a copay of $1790 per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and outpatient substance abuse services are covered, with coinsurance between 0% and 20%, and outpatient blood services are covered with 20% coinsurance. Ambulatory Surgical Center (ASC) Services are covered with a coinsurance between 0% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by Aetna Medicare Dual Complete (HMO D-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Dual Complete (HMO D-SNP), including ground and air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Dual Complete (HMO D-SNP) plan. For Emergency Services, there is a $110 copay and no coinsurance, and the copay is waived if admitted to the hospital within 24 hours; for Urgently Needed Services, there is a $45 copay and no coinsurance; and for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, there is no copay and no coinsurance.
Primary Care See details
Aetna Medicare Dual Complete (HMO D-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits have no copay. Individual and group sessions for mental health and psychiatric services have no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, as well as additional preventive services with a copay that varies depending on the service. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are covered with 20% coinsurance.
Hearing Services See details
Hearing services include Routine Hearing Exams with no copay and at most 20% coinsurance, and Fitting/Evaluation for Hearing Aids with no copay. Prescription Hearing Aids (all types) are covered with no copay, and a maximum benefit of $1250 per year, per ear. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance for routine eye exams, with no copay, and no copay for other eye exam services. Eyewear has a 20% coinsurance for contact lenses, and no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, up to a combined maximum of $275 every year.
Dental Services See details
The Aetna Medicare Dual Complete (HMO D-SNP) plan covers dental services with a 20% coinsurance, and has a maximum benefit of $1750 per year. Oral exams, dental x-rays, other diagnostic dental services, cleaning, fluoride treatment, and other preventive dental services are covered with no copay. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral/maxillofacial surgery are covered with no copay, but are limited in the number of visits. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Dual Complete (HMO D-SNP) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Dual Complete (HMO D-SNP) plan, but require prior authorization. The plan has a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Dual Complete (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Dual Complete (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of 0%, and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%. There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Complete (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Dual Complete (HMO D-SNP) plan. While Cardiac Rehabilitation Services are mentioned as a covered benefit, the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered and require prior authorization. This plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C, and additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Dual Complete (HMO D-SNP) plan covers Over-the-Counter (OTC) items with no copay and a maximum benefit of $125 per month, as well as a meal benefit with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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